What is the organ market, and why do we have one?

Around 2014, China reported that about 85,000 organs were transplanted, this was extremely shocking. For reference, the 2020 global amount was about 130,000. The question of where on earth these organs were coming from was raised and investigated. In 2019, it was revealed that they were extracting organs from their prisoners, specifically religious/ethnic minorities. Ethnic minorities such as Tibetans and Uyghurs and religious minorities such as Christians, Muslims and members of the Falun Gong. This is only one element of the illegal organ market and organ trade. For clarity’s sake, organ trade is the commercial trading of organs for transplantation. This happens outside the national medical system and comes with profit. This mass supply of organs attracts a lot of medical tourism. Medical tourism is where people who need medical treatment travel to places where it is cheaper and more easily accessible (sometimes illegal and often unethical). According to WHO, organs can only be donated, and buying/selling is illegal. The most common organs that are needed and traded are the following: kidneys, liver parts, lungs, heart, and corneas (eye).

When looking at the whole concept of illegal organ trade, the main problem is that demand =/ supply, the gap is widening and desperation grows. Let’s break down the problems that arise from this inequality. For visualization, annually, the transplant list grows by over 100,000 individuals in critical condition and in need of a life-saving organ. Unfortunately, half of them lose their battle before a donor can be found. Starting at the beginning, the way the organs are often extracted can be very violent and dangerous. Scott Carney, author of The Red Market discusses how (particularly) in rural areas the conditions of organ extraction can be harshest, people are kidnapped, anaesthetized and have their kidneys/organs removed without consent. “Carney visited an Indian refugee camp for survivors of 2004’s massive tsunami. Today, the camp is known by the nickname Kidneyvakkam, or Kidneyville, because of how common it is for the women who live there to sell their kidneys. KidneyVille is a place in India where (often) women are able to sell their kidneys for quick cash. Similar places are now rampant in places like Nepal and Afghanistan. Some might say: “well,l this doesn’t sound too bad, putting Capitalism to work”. The conditions under which the trades happen are very often extremely unhygienic and unsterile, which can lead to many infections and diseases. Studies were done that showed the p The final form of extracting organs is through trickery. Patients will already be in for surgery, and the doctor will illegally remove the kidney without the consent of the patient, or informing them afterwards (obviously). The second major issue is the rings of crime organ trading finds itself. Besides organ trafficking rings, it can closely be linked to human, sex and labour trafficking. These are all situations where traffickers can make a quick buck through the trafficked people. The final two things that add to the lack of supply are that organs are needed for medical students and pharmaceutical testing, as well as military practice ops. As an effect of these issues and the desperation that comes with it, targeting fragile groups of people is common. In Turkey, ads were targeting Syrian refugees to donate/sell their organs as a means to increase the supply. 

Now for the economics of it all: Who earns? Who benefits? and Who is paying? The incentive aspect is crucial to the existence and maintenance of this market. Basic theory tells us that when demand is high, the price grows That is the case here but with added pressure due to a very low supply. Medical desperation is understandable, and using your wealth to stay healthy is a normal and understandable sentiment. When looking at how much an organ costs, these things all have an effect. Carney predicted that a whole human body is worth about $250,000 dollars (2015). Many things can control the way price swings, for example, a young donor’s organs will be worth more than those of an old donor. It even comes down to where race/ethnicity can also have an effect, where a white person’s organs are found to be valued higher than a Chinese person’s organs. This element is eradicated when organs are fairly donated for no monetary compensation. The price of specific organs tends to vary, so there is no concrete number. The Guardian investigated transplant tourism between the UK and the US, the buyer bought a kidney for $100,000 and the donor ended up with $2,000 after all other expenses. Below you can see the network of people necessary for this transaction.

Asking ourselves why the W.H.O. bans illegal organ trading, comes down to preventing human exploitation. Kant famously said, “Act always in a way that expresses respect for the value of humanity”. It boils down to respecting human dignity, and sale/selling ourselves contradicts that. There are large debates and discussions happening today in medical academia about the ethics and philosophy of organ trading. Commercializing human body parts in itself is already quite dystopian, but the added consequences of furthering the division/gap between the rich and the poor, come with the poor perhaps getting out of poverty, but physically weaker. Another aspect of the discussion falls on the buyer’s end. Making the decision to seek and purchase an organ is not only monetarily denting but really makes one value their time in terms of prices. As a species, most will do whatever it takes to buy extra time, no matter the ethical dilemma or societal consequences. Exchanging health/physical strength for cash is a harrowing decision, but it is one will make for the sake of family/wealth. 

Finally, what exactly does the future hold regarding this illegal market, and what can we do? The first solution would be to legalize organ trade, this will end in the exploitation of the poor, plain and simple. Yes, legalizing it would ultimately make it safer for most transplants, but the disparity between the types of people donating and buying would be present and unethical. Secondly, in economic terms, we need to increase supply. This simply means more donors need to donate, and this can move the needle a bit. In the late 1990s, Spain introduced the idea of “presumed consent”, this means instead of actively signing up to become a donor, you are born automatically set up for being a donor when you pass away, and you can actively sign out. This has proven to be quite successful and most of Europe has adopted the policy. One concern about this is that there is fear of less effort being put into your resuscitation out of desperation and need for your organs. On the other end of the spectrum, efforts have recently been made in the US to allow for prisoners to donate organs in exchange for a lower sentence. This too encourages donation, but in an unethical manner. Finally, the most futuristic and optimistic solution would be artificially made organs. Today, it doesn’t exist quite yet, but there are large strides being made towards achieving it. Although in the beginning, it would be extremely expensive, if subsidized and automated, it could be a great option for the future.